Alcohol control policies reduce all-cause mortality in Baltic Countries and Poland between 2001 and 2020

Funding Information: Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIAAA) (Award Number 1R01AA028224). Publisher Copyright: © 2023, The Author(s).Alcohol consumption in the Baltic countries and Poland is among the highest globally, causing high all-cause mortality rates. Contrary to Poland, the Baltic countries have adopted many alcohol control policies, including the World Health Organization (WHO) "best buys". The aim of this study was to evaluate the impact of these policies, which were implemented between 2001 and 2020, on all-cause mortality. Monthly mortality data for men and women aged 20+ years of age in Estonia, Latvia, Lithuania, and Poland were analysed for 2001 to 2020. A total of 19 alcohol control policies, fulfilling an a-priori defined definition, were implemented between 2001 and 2020 in the countries of interest, and 18 of them could be tested. Interrupted time-series analyses were conducted by employing a generalized additive mixed model (GAMM) for men and women separately. The age-standardized all-cause mortality rate was lowest in Poland and highest in Latvia and had decreased in all countries over the time period. Taxation increases and availability restrictions had short-term effects in all countries, on average reducing the age-standardized all-cause mortality rate among men significantly (a reduction of 2.31% (95% CI 0.71%, 3.93%; p = 0.0045)). All-cause mortality rates among women were not significantly reduced (a reduction of 1.09% (95% CI - 0.02%, 2.20%; p = 0.0554)). In conclusion, the alcohol control policies implemented between 2001 and 2020 reduced all-cause mortality among men 20+ years of age in Baltic countries and Poland, and thus, the practice should be continued.publishersversionPeer reviewe

Impact of the WHO “best buys” for alcohol policy on consumption and health in the Baltic countries and Poland 2000–2020

Funding Information: Funding: Research reported in this publication was in part supported by the (U.S.) National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), grant number 1R01AA028224 . This research was conducted as part of the project ‘Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states’ and we would like to thank the whole team for their input to wider discussions in generating the research reported in this paper. Content is the responsibility of the authors and does not reflect official positions of the NIAAA or the NIH. Publisher Copyright: © 2023Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.Peer reviewe

Long-term risk of myocardial infarction after a first-ever stroke

Purpose. To examine the incidence of myocardial infarction during the first three years after a first-ever stroke. Material and methods. Both Kaunas community-based stroke register and ischemic heart disease register served at the primary source of data. The methods used for data collection were those applied by the World Healt Organisation (WHO) for the WHO MONICA project. During 1986 to 1994, 2531 patients aged 25 to 64 years with a first-ever stroke were registered and followed-up for three years for the information on the firstever acute myocardial infarction or death from ischemic heart disease. Actuarial life tables were used to analyze risk of myocardial infarction. Results. During the study period, 58 patients with the first-ever acute myocardial infarction that occurred among the first-ever stroke survivors were identified. Fifty-three first-ever ischemic stroke survivors (39 (73.6%) men and 14 (26.4%) women, (p=0.07)) experienced their first-ever myocardial infarction. The cumulative risk of suffering an acute myocardial infarction was 3.5% (95% confidence interval 2.6 to 4.4%) by 3 years: in male ischemic stroke survivors this risk accounted for 4.3% (95% confidence interval 3.0 to 5.6%) and in female \u96 2.3% (95% confidence interval 1.1 to 3.5%). The risk was the highest one early after ictus in the ischemic stroke survivors: 0.5% (95% confidence interval 0.2 to 0.8%) by 3 months (men \u96 0.7% (95% confidence interval 0.2 to 1.2%), women \u96 0.3% (95% confidence interval 0.0 to 0.7%)). Conclusion. The risk of myocardial infarction is the highest early after the first stroke, although due to relatively small number of cases confidence intervals were too wide to reach a statistical significance

The Prevalence of Burnout and Its Associations With Psychosocial Work Environment Among Kaunas Region (Lithuania) Hospitals' Physicians

The primary prevention of occupational burnout should be considered as a public health priority worldwide. The aim of this study was to evaluate the prevalence of burnout and its associations with the work environment among hospital physicians in the Kaunas region, Lithuania. The cross-sectional study was carried out in 2018. The Job Content Questionnaire (JCQ) and the Copenhagen Burnout Inventory (CBI) were administered to examine occupational stress and personal, work-related, and client-related burnout among 647 physicians. Logistic regression analysis was applied to determine the association between dependent variable burnout and psychosocial environment among physicians, adjusting for potential confounders of age and gender. The prevalence rate of client-related, work-related, and personal burnout was 35.1%, 46.7%, and 44.8%, respectively. High job control, lack of supervisor, coworker support, job demands, and job insecurity were significantly associated with all three sub-dimensions of burnout. High job demands increased the probability of all three burnout dimensions, high job control reduced the probability of work-related, and client-related burnout and high job insecurity increased the probability of client-related burnout. The confirmed associations suggest that optimization of job demands and job control and the improvement of job security would be effective preventive measures in reducing occupational burnout among physicians

Peculiarities of medical students’ nutrition

The aim of the study was to investigate the peculiarities of medical students’ nutrition, to compare the dietary habits between first-year and third-year students, to compare male and female students’ nutrition, and to evaluate the tendencies of its change. Material and methods. An anonymous survey using a specially designed questionnaire was carried out on 349 first- and third-year students of the Faculties of Medicine and Pharmacy at Kaunas University of Medicine. Students’ factual nutrition was evaluated by the number of meals per day, the time of eating, and the frequency of consumption of food products. The findings of the questionnaire-based study were stored in a database and analyzed using Excel software. Statistical relationships were determined using EPI Info software by applying the nonparametric c2 criterion. Statistical significance was determined using Student’s criterion. Results. The nutrition of first- and third-year students is irregular and differs in the time and number of meals. Only 20% of students daily ate 400 g of fruit and vegetables as recommended by the World Health Organization. Medical students, especially males, used excessive amounts of animal fat. Every seventh student consumed too salty food. Medical students consumed insufficient amounts of bread, potatoes, cereals, and other products that constitute the basis of the pyramid of healthy nutrition. Twenty-three percent of males and nearly as many females used alcohol once per week. Nearly one-half of students did not exercise at all, and 9.1% of third-year female and 14.5% of third-year male students were overweight. Conclusions. The majority of students did not follow the dietary regimen and consumed the majority of food products during the second half of the day. Students’ nutrition was not balanced – medical students consumed too much fat, especially those of animal origin. Students consumed insufficient amounts of vegetable fats and fish products, fruit and vegetables, and thus their food may lack soluble dietary fibers and vitamins. First-year and third-year female students used vegetable oils more frequently, used more vegetables, and complied with dietary regimen more often than male students. The nutrition of first- and third-year students does not differ statistically significantly. Alternative types of nutrition (vegetarian nutrition and various diets) are not popular among medical students

The Effect of Atmospheric Temperature and Pressure on the Occurrence of Acute Myocardial Infarction in Kaunas

Objective. The aim of the study was to evaluate the impact of meteorological variables (atmospheric temperature and pressure) on the daily occurrence of acute myocardial infarction (AMI). Material and Methods. The study used the daily values of atmospheric temperature and pressure in 2000–2007. The meteorological data were obtained from the Lithuanian Hydrometeorological Service for Kaunas. The relative risks of event occurrence were computed for 5°C atmospheric temperature and for 10-hPa atmospheric pressure variations by means of the Poisson regression model. Results. The occurrence of AMI and atmospheric temperature showed an inverse linear relationship, while the occurrence of AMI and atmospheric pressure, a positive linear relationship. Among the youngest subjects (25–44 years old), no relationships were detected. Contrary, among the subjects aged 45–64 years and those aged 65 years and older, the occurrence of AMI significantly decreased with higher temperature (P=0.001 and P=0.002, respectively). A decrease in atmospheric temperature by 10ºC reduced the risk of AMI by 8.7% in the age groups of 45–64 and 65 years and older and by 19% in the age group of 25 years and older. Among the first AMI cases, the risk increased by 7.5% in the age group of 45–64-year olds and by 6.4% in the age group of 25–64-year olds. The relationship between atmospheric temperature and pressure, and AMI occurrence was found to be linear but inverse. An increase in atmospheric pressure by 10 hPa resulted in an increase in risk by 4% among the subjects aged 65 years and more and by 3% among the subjects aged 25 years and more. Conclusions. Atmospheric temperature and pressure variations had the greatest effect on middle- aged and aging subjects (starting from 45 years). At younger age, the effect of such factors on the AMI risk was considerably lower

Hypertension, serum lipids and cancer risk: A review of epidemiological evidence

Although the association between blood pressure, serum lipids and cancer risk has been investigated, the results are controversial. The aim of this literature review was to examine the epidemiological evidence and provide overview of the association between blood pressure, serum lipids and cancer risk. The arterial hypertension is closely linked with renal cell cancer development. Risk of renal cell cancer was 2–4 times higher for persons with arterial hypertension, independently of sex. In some studies arterial hypertension as one of the components of the metabolic syndrome, was associated with a higher risk of colorectal, prostate cancer and malignant melanoma. Studies suggest that a higher total serum cholesterol level is linked with higher risk of colorectum, colon, prostate and testicular cancer and lower risk of stomach, liver and hematopoietic and lymphoid tissues cancer. There was positive association between serum triglycerides and esophageal, colorectal, lung, renal, thyroid cancer. Given that hypertension is a common risk factor worldwide and its control remains inadequate, our analysis supports the relevance of public health programs aimed at reducing hypertension to reduce the incidence of a number of cancers including renal cell cancer. Effective cholesterol control may lower the risk of cancer, but further studies with longer follow-up and repeated measurements of cholesterol and other lipids are needed

The Impact of metabolic syndrome and lifestyle habits on the risk of the first event of cardiovascular disease: results from a cohort study in Lithuanian urban population

Background and Objectives: In recent years, the impact of individual risk factors on mortality from cardiovascular diseases (CVD) has been often investigated. However, there is a lack of studies that have evaluated the relationship between lifestyle habits, metabolic syndrome, and their combined influence on the first event of CVD. The aim of this study was to investigate the impact of metabolic syndrome and lifestyle habits on the risk of the first event of CVD in a Lithuanian urban population. Materials and Methods: The presented data were collected from a survey that was carried out within the framework of the international project Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE). For statistical analysis, 4257 participants aged 45–72 years were selected (with a follow‐up of 11 years). Results: The findings from the Cox proportional hazards regression multivariable analysis showed that metabolic syndrome, current smoking status, and former smoking status increased the risk of the first event of CVD among men (with respective hazard ratios (HR) of 1.53, 1.94, and 1.43; p < 0.01). In women, metabolic syndrome increased the risk of the first event of CVD (HR = 1.56; p = 0.001), while the increased consumption of fresh vegetables and fruits decreased the risk of the first event of CVD (HR = 0.80; p = 0.003). Multivariable logistic regression analysis results show that a level of increased physical activity by one hour can be linked to a lower risk of metabolic syndrome by 2% among men (odds ratio (OR) = 0.98; p = 0.001). Conclusions: Metabolic syndrome and lifestyle habits including cigarette smoking in men and low consumption of fresh vegetables and fruits in women are strong predictors of the first event of CVD